Fifty years after the first dialysis treatments, nutrition is still a
recurrent issue and many disorders are currently not well
understood. However, there has been progress in nutritional
targets in CKD patients before and during maintenance
treatment. Before dialysis, there is good evidence that a longstanding
nutritional care plan, with a control of protein
intake, is efficient in correcting many metabolic disorders,
including proteinuria, and is cost-effective. During dialysis,
nutritional targets have gained in understanding and
phosphate metabolism does not appear a sufficient issue to
reduce protein intake, as compared with the risk of superimposed
mortality when patients’ intakes are reduced. New
devices recording physical activity report dramatically
reduced energy expenditure in dialysis patients and call for
sustained physical activity plans as a part of routine
treatment. New classification of nutritional disorders in
CKD patients may help physicians to more easily identify
initial protein–energy wasting. Finally, inflammation, a
common CKD disorder, is responsible for anorexia and
catabolism, but inflamed patients can respond to supplemental
nutrition as well as noninflamed ones.